The main symptom of anal fissure is persisting pain caused by defecation. It can last for several hours and abates very slowly. It can be burning, stabbing, piercing, dull, or even exert pressure. It can radiate into neighboring areas and become manifest or even increase while sitting, walking, or coughing. Passing of gas, too, can trigger pain symptoms.

The intensity of pain does not correlate with the extent of the anodermal defect, but decreases with chronicity. Many patients use laxatives to keep the stool as soft as possible and thereby reduce pain during defecation.

Quite often, defecation is even suppressed to avoid a new pain attack. But this can lead to the impaction of stool.

As already mentioned, the intensity of pain decreases with time. This explains the wide range of pain complaints during anamnesis (46–100%), as is shown by the analysis of 14 publications which comprise 4047 anal fissure patients (Table 6.1).

After defecation, a strip of bright red blood is often found on the column of stool and/or on the toilet paper.

The analysis of 13 studies concerning 4019 patients (Table 6.2) shows that the symptom “rectal bleeding” is found within a range from 33 to 88% of the cases, that is, 72.6% on average.

Anal bleeding is not exclusively caused by anal fissures. Other proctological diseases, like hemorrhoidal disease, colorectal carcinomas, polyps, chronic inflammatory colon diseases, and diverticulitis, which generally do not go along with pain induced by defecation, must be ruled out.

Among 102 patients under 50 years of age suffering from rectal bleeding, Korkis and McDougall (1995) found four patients with anal fissure, eleven patients with polyps, five with diverticulosis, and six patients with colitis.

Occasionally, patients complain of secretion from exuding wounds, which leads to anal pruritus without or with formation of an irritant toxic eczema in the perianal region. Moreover, hypertrophied anal papillae and fistulae can develop, which cause stool soiling. Sentinel tags complicate anal hygiene, and thus favor an anal eczema.

The analysis of 13 publications involving 3539 patients (Table 6.3) found pruritus ani in 25.4% on average (6–75%) and secretion in 1–26% of patients.